Provider Demographics
NPI:1477665305
Name:BRAYKO, CRAIG M (MD)
Entity Type:Individual
Prefix:DR
First Name:CRAIG
Middle Name:M
Last Name:BRAYKO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:401 15TH AVE S
Mailing Address - Street 2:#201
Mailing Address - City:GREAT FALLS
Mailing Address - State:MT
Mailing Address - Zip Code:59405
Mailing Address - Country:US
Mailing Address - Phone:406-727-2121
Mailing Address - Fax:406-727-2147
Practice Address - Street 1:401 15TH AVE S
Practice Address - Street 2:#201
Practice Address - City:GREAT FALLS
Practice Address - State:MT
Practice Address - Zip Code:59405
Practice Address - Country:US
Practice Address - Phone:406-727-2121
Practice Address - Fax:406-727-2147
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2009-12-03
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MT4905207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT0071929Medicaid
MTE28032Medicare UPIN
MT000001769Medicare Oscar/Certification